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Case:Miss Molly
Molly was diagnosed on Christmas Eve day 2005. Molly has asthma and allergies. One allergy is pork, this ruled out Vetsulin/Caninsulin as an option. She was started on Humulin N. The problem we encountered was Molly's reluctance to eat a full meal in the morning. At the time of diagnosis she went totally off dog food. She was on Science ID for 9 years. We tried every dog food we could find in our area, we even mixed chicken in with it and still she refused. We decided to go with a home cooked diet using the standard 50% meat, 35% veggie's, and 15% fiber. (The mainstay being ground turkey or chicken, baby food meat, green beans, squash, cottage cheese and oatmeal). The only complication we had initially was that Molly was not a veggie kind of girl. We also discovered that white rice and brown rice sent her blood glucose soaring. Molly's food also includes C-Biotic by Wysong supplement and Milk Thistle, 1/2 capsule twice a day, 5 days a week. (3/4/07) We have added a little Add-Life by Wysong to her food and Shasha's Blend for her knee's (seems to be helping a lot). Thank Goodness it was at this time we found the Pets with Diabetes forum. With their help and encouragement we learned how to do Molly's blood glucose test at home. They also educated us about insulin and food. Needless to say they have my undying gratitude and due to their experience and knowledge have saved Molly's life. We found a vet with more experience with Diabetes. He changed Molly's insulin to Lantus once a day. Lantus was not giving us 24 hour duration. The board suggested and the vet concurred that 2x a day every 12 hours would be good. Lantus for Molly begins in 1 to 2 hours, peaks at 5 to 6 and is out of her system in about 11 hours per injection. The advantage to this was that her morning injection did not have to be early, allowing Molly to have her morning meal about 11 a.m.. It was difficult at first but she now will eat a small morning meal and her main evening meal about 6:00. The Lantus was doing a very good job serving as her basal insulin but we still had the postprandial rise. The board suggested Humalog to cover her meals. This proved to be, in my opinion a stroke of genius! Of course I knew nothing about Humalog. With their help I learned and so did our vet. The Humalog, given after her meals is a very rapid insulin. For Molly it starts in 10 to 15 minutes, peaks at about 2 hours and is out in 3 to 3 and a half. This allows us to cover that postprandial rise without overlapping the Lantus peak times. We have had occasions when the Humalog was not needed but most of the time it is. Blood test results for Molly in the beginning: In the beginning Molly's blood work was not good she had low MCV range 58-79), Platelets were slightly increased. 533, (range-170-400). Total Protein was high, 7.7 (range 5.0 to 7.4), Albumin 4.8, (Range 2.7 to 4.4). Cholesterol 646. (Range 92-324). BUN was 42, (Range 6-25). Creatinine 2.1 (Range 0.5-1.6). Calcium 11.7, (Range 8.9- 11.4). Lipase, 980, (Range 77-695). Potassium 6.9, (Range 3.6-5.5). Triglyceride 497, (Range 29-291). Osmotality, Calculated, 323, Range 277-311). Magnesium 2.9, (Range 1.5-2.5). Her values improved in March/06 but she was still high in Urea and Creatinine. Her latest blood work shows everything normal with the exception of her blood glucose and that was because it was before her insulin injection. Molly's Thyroid, normal. Addison's and Cushing's test's negative. Ultrasound of abdomen, the doctor said " her organs did not look like the organs of a diabetic" , the only thing she saw was on the outside of her left adrenal gland, it was different around the egdes, our vet said it could just be the way she is made. Sterile urine test, negative. Latest ultrasound Oct. 06. Slight change in liver, normally seen in diabetic patients, left adrenal gland remains the same. Ophthalmologist check on 4/19 showed cataracts but the kind from aging, not from diabetes. Diagnosis: Incipient & immature cortical cataract. Tonometry 10mmHg 12mmHg July's visit, 18 mmHg and 17 mm Hg. Opthamologist check 10/26/06. Some changes from last visit. Little specks in the eye getting a little larger and some lines coming out from them. These are age related not diabetes related. Senior Wellness blood work 12/06 all normal with exception of blood glucose. Molly usually goes low at the vet's so I decreased her Lantus by 1/3 the night before. When I took her to the vet her bg was 225 and when we got home after the vet fed her a little food her bg was 125. Molly is a Silky terrier weighing 11.4 lbs. Her typical daily dose of insulin's are: Lantus 2x twelve hours apart, Morning dose 2 units Lantus. Humalog post meal. Depending on how much she eats and how high her blood glucose is she requires between 1/2 to 3/4 units of Humalog, per meal, rarely requiring a full unit. We have discovered with allergy/ asthma season that it is taking about 1/4 to 1/2 more units than before. Molly was on Albuterol for her asthma for years. She has been on Flo-vent with the aid of an inhaler , it is working so much better for her. This is the first time in years (2006) that we have been able to get through the allergy season without prednisone and bronchial dilator shots. 3/20/07 We suspect that the Flo-Vent may have influence her diagnosis of Atypical Cushings 12/06. The IMS is still working with other endocrinologist to get to the bottom of it. Molly is playing more and getting bossy again and that is music to our ears! Her sense of humor is back. She tries to slip off to bed before her evening shot. She is great about the bg testing, she doesn't like it but tolerates it well. Update 12/06 Molly has celebrated her 1st Anniversary since being diagnosed. This year has been a tremendous learning experience for our whole family. Molly has been diagnosed with Atypical Cushing's. She was tested twice for Cushing's and the result's were negative. Her ultrasound spotted a node on her left adrenal gland. We are taking her to a specialist in MI to obtain more information. We are located in Canada. Our thanks to our vet here for going the extra mile. She helped us to do a full adrenal panel and send it to UT Knoxville, USA. Our deepest gratitude to Dr. Oliver and his staff. Note* (Molly also has asthma and requires Flo-Vent inhaler 3 times a day. She has had two ultrasounds one in April and one in October where they found a node/blemish, on her left adrenal gland). 2/17 Update: Preliminary report from Internal Specialist: The doctor said her ultrasounds were reviewed by their ultrasonagraphers and "at this time, they have confirmed the presence of the hypechoic area on left adrenal gland. Both adrenals are otherwise within normal echo limits." He said, "Many of the hormones and drugs have a steroidal configuration and, hence, there is the possibility of some cross reactivity in the assays that are used to try to assess and understand her overall hormonal milieu." He also said that whether there is sufficient evidence to conclude that she has AC "in light of her diabetes and her medications is still a question for which I do not yet have an answer of confidence ". He is continuing to work on this and will get back with us. Molly was also diagnosed with cruciate knee ligament damage in both knee's. Our regular vet referred us to an orthopedic surgeon and we consulted with our holistic vet. After much research and considering the recouperation time was 3 months for each knee, we opted to try the holist way first. She had three sessions (the vet said may take 5) of acupunture and natural medicine into her knee's. She was put on Shasha's Blend (which I would highly recommend to anyone needing help with joint pain). We are happy to report that she is not limping. We have also learned that this has to do with Atypical Cushing's. Update: 2/14/07 Molly's appointment at MSU went well on 1/25. The left adrenal gland does not have a tumor. They called it a blemish or just the way she is made. We are waiting to hear from them on the rest of their evaluation. The good news is that all of her blood work is normal with the exception of her blood glucose and she is fighting a UTI at the moment. Update 2/14/07, Molly is over the UTI (E. coli) after 4 weeks, two rounds of Baytril. We found Baytril/or the UTI increased her blood glucose on the average 70 points. Molly still negative for UTI 3/20/07. Update 5/8/2007 Molly continue's to be "well regulated" according to her fructosamine tests on Lantus for her basal insulin and Humalog for her meal bolus. She currently is going through a bout of pancreatitis. She is doing ok. Her recent ultrasound shows that the growth on the adrenal gland is growing. Aspiration is not an option because it is so close to the aorta. The good news is that they do not think, from the ultrasound, that it is malignant. Flo-vent is helping her Asthma but could be influencing the tests that showed Atypical Cushings in Dec. 2006. We have started her on Prozyme, a pancreatic enzyme to aid her pancreas. We really need to acknowledge the wonderful people on the Pets with Diabetes board, especially Natalie, Chris' mom, Margo, Alex's mom, Denise, Bogie's mom, Terry, Missy and Naddie's mom, Helen, Missie's mom, and so many others I wish I could list all. A special thank you to Chris, Alex, Bogie, and Missy, and Missie, because of your wonderful love and your beautiful spirits you moms are honoring you and saving lives every single day. Thank you, does not say enough. Miss Molly and her momma and poppa October 2006. 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